Fecal incontinence after childbirth: a rarely talked about problem

When we talk about childbirth, we often cover the common things a woman experiences in her recovery: soreness, bleeding, breast tenderness, and stretch marks. But rarely do we discuss fecal incontinence, or leakage of stool. This is unfortunate because if your doctor or midwife doesn’t bring it up, you might be too embarrassed to share—and that means you miss out on the care you deserve.

Fecal incontinence is not that uncommon, with about 7 to 15 percent of women being affected by it. The sad part is that less than 3 percent of those women will discuss it with their doctors and have it become part of their medical record. This means many are suffering alone, mainly because they are often not being directly asked about it.

Leaking stool can be traumatic as you can probably guess: it can lead to embarrassment, decreased quality of life, and in some societies extreme social stigma where these women are asked to leave their communities or they are ignored completely.

The most common cause of fecal incontinence for women is obstetric anal sphincter injuries. There are two anal sphincters that work together to hold in stool and gas, and during a vaginal delivery they can be torn or damaged. If it is not recognized or they are not properly repaired, fecal incontinence can result.

Risk factors for fecal incontinence related to childbirth include giving birth vaginally (as opposed to a C-section), having forceps or a vacuum used at the time of delivery, and giving birth to a large baby. It’s not all just childbirth, however: smoking, obesity, older age, and lack of exercise can all play a role too.

Treatment is different for each woman. For some, changing your diet or taking certain medications can help prevent looser stools and help with leakage. Others will need pelvic floor physical therapy, injections into the sphincter to make them stronger, or surgery to repair the sphincters.

Ideally, all women who have given birth would be screened for fecal incontinence at their postpartum visits. Since this can feel like an embarrassing topic, it is important for doctors or midwives to ask about this directly so a woman knows she can talk about it and not feel like she has to hide it.

The good news is that for women who have stool leakage related to issues with childbirth, most can be treated and go back to their normal lives. The key is feeling like you can talk about it and seek treatment, so don’t ever be afraid to speak up and get the help you need!